Any assessment or
diagnostic technique that seeks to make sense of what’s happening inside the
human system is inherently pretty complex – be it a modern tool such as a CT
scanner, or a traditional device such as the stethoscope. Interpretation is
tricky, and the background knowledge required can often be intimidating. While
using the tongue and pulse to get a glimpse inside the human body is not an
exception, one can nevertheless glean really useful, actionable information
with even a basic understanding of the technique. This basic understanding can
become richer and deeper with ongoing practice. The complexity evidenced in
traditional texts on the subject should not be a reason to keep you from
experimenting!
Basics: Excess /
deficient. Hot / cold. Dry / moist. The polarities!
Pick two people and look at their faces. Feel their skin.
Who is more red? Whose skin more dry? Who speaks more loudly and often? Who is
more reserved and shy? The answers to these questions are clinically relevant,
and it is in these basic categories that we will try to fit our observations of
pulse and tongue. They have been universally recognized in traditional healing
systems, from Chinese yin/yang theory to the Western humors.
The Pulse: Neuromuscular
tension and tone
When feeling the pulse, set your fingers on the
radial artery. It can be found on the palm side of the wrist, right where the
hand (thumb side) ends. You can often find a pair of strong tendons here; feel
for the pulse in the little “trench” just above these.
What we can learn from pulses: relative state of anxiety,
tension, stress. Underactivity in the heart, vessels, and spirit (or,
conversely, overactivity).
Herbs we can use to rebalance pulse: aromatic plants, and
sometimes rooty, nourishing adaptogens. Archetypal plant for the pulse: Holy
Basil (Tulsi – ocimum sanctum).
Polarities to observe:
-
The pulse has a depth. It is right on the surface,
somewhere in the middle, or deep down. This is determined by the amount of
pressure required to find it. Surface pulse with no depth indicates “paper
fire” (quick burnout, moody and changeable, hyper then crashing. Consider lavender,
linden). Deep pulse that’s hard to find can mean depletion (hard to get going,
tends to depression, fatigued. Consider ashwagandha, ginger, cayenne, green
tea).
-
The pulse has a width. Think of the artery as a river,
ideally flowing through the middle channel of depth. If it’s full and
noticeable at all depths, it might be called “flooding” (excess function, high
blood pressure, over-intensity. Consider motherwort, rose). If it’s thin and
feels like a string, it might be called “tight” (high tension, excess
sympathetic discharge. Consider motherwort again, lemon balm, scullcap). If
it’s just thin, it might be a sign of deficiency and we would turn to the
nourishing herbs (ashwagandha, oat, licorice, American ginseng).
-
The pulse has a speed. This is a pretty classic
assessment: greater physical activity usually raises the pulse rate. When
sitting, speedy pulses usually indicate anxiety or poor physical conditioning.
Aromatic plants and exercise are called for. In extreme situations (requiring
hospitalization: shock, toxicity, severe dehydration) you can see rapid, thin
pulses too – but hopefully you won’t ever run in to these as they are emergency
situations.
-
The pulse should respond to breath. Feeling the pulse, have
the person take a deep, full breath slowly. The pulse should quicken on inhale,
and slow down noticeably on exhale. Failure to do so indicates poor heart rate
variability: if the pulse has low depth, feels thin or absent, consider
nourishing and building here (ashwagandha, oat, licorice, American ginseng). If
the pulse is of surface depth, flooding, or tight consider aromatherapy, and
any aromatic plants (chamomile, linden, lemon balm, scullcap, mint, rose,
yarrow).
-
The pulse should come back well after being completely
blocked. Occlude the artery by pressing hard, then feel for the return of
blood. Slow return to the “normal” state (taking more than 1 second) may
indicate blood stagnation (purple color, cold, areas of chronic pain. Consider
yarrow, elderflower, Salvia milthiorrhiza)
Basically, aromatic nervines make great teas and
are often just the ticket for an imbalance in the pulse. This is because the
radial pulse reflects the degree of sympathetic, or fight-flight, tone really
well, and these plants are supremely useful for those who have either excessive
or deficient tension in their systems. They modulate how we respond to change
in the world within and without – and if we’re not doing a great job of it, the
pulse tells us. If the pulse truly seems weak, sunken, and/or thin, you might
want to add nourishing adaptogens as well to provide a literal foundation for
stress hormone production, not just a way to balance response.
The Tongue: state of the
mucous membranes
When looking at the tongue, ask the person to really open
wide and stick their tongue out completely. Then, tell them to relax it (often
the “sticking out” causes the tongue to get really tight and weirdly-shaped).
What we can learn from the tongue: relative state of
activity and moisture of the membranes that line the GI tract, but also the
respiratory passages by reflex. Degree of inflammation. Degree of swelling /
moisture.
Herbs we can use to rebalance the tongue: bitter and
astringent plants. Archetypal plant for the tongue: Agrimony (Agrimonia
eupatoria).
Polarities to observe:
-
The tongue has a body color. This is the general hue of
the tongue itself, not its coating, and indicates the degree of blood flow and
activity in the mucous membranes. Pale tongue can indicate anemia, poor
nutrition (consider yellowdock, rehmannia, protein). Red tongue indicates
inflammation and irritation (consider dandelion and also slippery elm or
meadowsweet depending on dry vs moist below). Purple: blood stagnation (see
above).
-
The tongue has a coat. It should be whitish/gray, and
relatively thin. Absent coat calls for soothing, especially with a red body
(consider slippery elm, licorice, flax seed meal). Thick coat calls for
bitters, especially if the coat has any signs of yellow in it – though watch
for coffee stains! (consider dandelion, yellowdock, burdock)
-
The tongue has a shape, largely determined by its
moisture (though the coat can tell us about moisture, too). Wider, thicker,
glistening tongues indicate a swollen, boggy gastric mucous membrane. Often
there will even be the scallops of tooth marks on the side (consider specific
bitters such as goldenseal or barberry, but also meadowsweet, cleavers). Thin,
wrinkly tongues indicate an atrophied, dry gastric mucous membrane (consider
dietary oils such as sesame, bitters, and potentially soothers such as slippery
elm especially with redness).
Basically, bitters are often a great choice for any
tongue signs, except maybe in cases where the tongue is really pale and wet and
there are symptoms of looseness in the bowel. This is because bitter herbs
stimulate and awaken digestive function, and tone the mucous membranes in the
process. They help us deal well with what comes to us from the world outside
(most often food) by making sure that the interface (the mucous membrane) is
functioning well. The tongue is a convenient piece of mucous membrane we can
always observe!
Conclusion
None of the diagnostic signs are infallible, of course –
and should always be read in the context of symptoms and case presentation. The
assessment of pulse and tongue can precede the oral interview, and guide it:
for instance, feeling a tight and rising pulse with poor response to breath,
you might want to ask about tension, anxiety, and a difficult response to
life’s changes and stresses. Or noticing a dry and red tongue, you might ask
about heartburn and/or constipation. Conversely, the assessment can come at the
end of the oral interview, and be used to corroborate information obtained
through conversation. Finally, the maxim: treat the person, not the tongue
(or pulse)!
